Trichotillomania or Excoriation
Overview
Trichotillomania, also known as hair-pulling disorder, is a mental health condition characterised by recurrent and compulsive pulling out of one's own hair, leading to noticeable hair loss. This behavior often occurs as a way to relieve tension or stress, and individuals may feel a sense of gratification or relief after pulling out hair strands.
Excoriation disorder, also called skin-picking disorder or dermatillomania, involves recurrent and compulsive picking at one's own skin, resulting in skin lesions or damage. This behavior is typically driven by a sense of anxiety or tension, and individuals may find temporary relief or satisfaction from picking at imperfections or perceived flaws in the skin.
Both trichotillomania and excoriation disorder are classified as obsessive-compulsive and related disorders in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Treatment often involves cognitive-behavioral therapy (CBT), habit reversal training, and sometimes medication to help manage symptoms and reduce compulsive behaviors.
Key Features
Trichotillomania (Hair-Pulling Disorder):
Compulsive Hair-Pulling: The primary feature is recurrent and irresistible urges to pull out one's own hair, resulting in noticeable hair loss. Hair can be pulled from the scalp, eyebrows, eyelashes, or other body areas.
Tension Relief: Hair-pulling often provides a sense of relief or gratification but is typically followed by feelings of guilt, shame, or embarrassment.
Attempts to Stop: Individuals with trichotillomania may make repeated efforts to stop or reduce hair-pulling behaviors but find it challenging to control.
Impact on Functioning: Hair loss can lead to significant distress or impairment in social, occupational, or other areas of functioning.
Associated Behaviors: Some individuals may engage in rituals or behaviors related to hair-pulling, such as inspecting hair roots or playing with pulled-out hair.
Excoriation (Skin-Picking Disorder):
Compulsive Skin-Picking: The primary feature is recurrent picking at one's own skin, resulting in skin lesions, scars, or tissue damage. Common areas include the face, arms, and hands.
Sense of Relief: Skin-picking is driven by urges to alleviate anxiety, tension, or perceived imperfections in the skin. It may temporarily reduce distress but is often followed by feelings of regret or guilt.
Attempts to Stop: Individuals often struggle to control or reduce skin-picking behaviors despite awareness of their harmful consequences.
Impact on Functioning: Skin-picking can cause significant impairment in daily life, affecting relationships, self-esteem, and physical health.
Associated Features: Some individuals may engage in specific rituals before or after picking, such as using tools, examining skin imperfections, or attempting to conceal resulting lesions.
How We Can Help
Cognitive-Behavioral Therapy (CBT): CBT is the gold standard treatment for both disorders. Psychologists use CBT techniques such as habit reversal training (HRT), which helps individuals identify triggers for hair-pulling or skin-picking, develop alternative responses, and learn coping strategies to manage urges.
Exposure and Response Prevention (ERP): For individuals with severe symptoms, psychologists may utilise ERP, a form of CBT that exposes the individual to triggering situations (such as mirrors or stressful situations) while helping them resist the urge to engage in hair-pulling or skin-picking behaviors.
Mindfulness-Based Interventions: Mindfulness techniques can help individuals become more aware of their thoughts, emotions, and bodily sensations without judgment. This awareness can reduce impulsivity and increase their ability to manage urges to engage in hair-pulling or skin-picking behaviors.
Psychoeducation: Psychologists provide information about Trichotillomania and Excoriation, helping individuals and their families understand the nature of these disorders, common triggers, and effective coping strategies.
Identifying and Addressing Underlying Issues: Psychologists explore underlying factors such as stress, anxiety, depression, trauma, or perfectionism that may contribute to hair-pulling or skin-picking behaviors. By addressing these issues, psychologists can help individuals develop healthier coping mechanisms.
Supportive Counseling: Psychologists offer a supportive and non-judgmental environment where individuals can express their feelings of shame, guilt, or embarrassment associated with hair-pulling or skin-picking. This support can empower individuals to make positive changes and improve self-esteem.
Family and Social Support: Involving family members or close friends in therapy sessions can enhance understanding and support for the individual with Trichotillomania or Excoriation. Psychologists educate loved ones about how they can provide effective support and encouragement.
Mediation: In some cases, psychologists may work with psychiatrists or medical doctors to consider medication options that can help manage symptoms of anxiety or depression that may exacerbate hair-pulling or skin-picking behaviors.
Living with these disorders can feel isolating, but remember, you are not alone. If you find that you're struggling, reach out to our team of professional psychologists who are here to help guide you through this journey. Contact us today to take the first step towards managing these behaviours and reclaiming control over your life.